What will happen to you if, when you get old, you need some additional support to that provided by family and friends? If you have health care needs, and the current system prevails, you’ll be able to automatically get help, free at the point of delivery, through the NHS. However, if you have social care needs, you may have to pay, depending on your circumstances.

It might seem artificial to separate health care needs and social care needs in a person’s life, but it is an administrative division that has major consequences for what support is automatically free and what is subject to eligibility tests of levels of needs and what financial resources you have.

Perhaps you think that if you do get in to this situation a nice social worker will come to your house and sort out all kinds of care for you so you don’t have to think about it too much now. Perhaps you have kept up with the latest developments in personal budgets in social care and think that you’ll have one of those to organize your own support plans. Perhaps, perhaps, perhaps.

Thinking about what will happen to us if we develop social care needs is a question we are not very good at asking ourselves, for all sorts of reasons. But I’d ask you to pause for a few minutes and think about your hopes and expectations as you read about this research report from a team at the King’s Fund and the Nuffield Trust.

The context

I have blogged on the social care elf earlier about the demographic changes we are experiencing of more people living longer, and many developing more complex care needs. These are big issues facing us as a society.

In their report, Humphries et al. examine the current state of social care for older people, how local authorities are coping, the impact on the NHS and older people’s experiences of the system. They analysed a range of national data and existing reports, and undertook four case studies of local authorities across England. In these, they conducted semi-structured interviews and focus groups. They also drew on a parallel piece of work in which older people were interviewed about their experiences of using social care services, both as a carer and as a service user.

The report reviewed published national performance data as well as semi-structured interviews and workshops with local authorities.

The headline message of the report is stark:

“The social care system in its current form is struggling to meet the needs of older people. Six consecutive years of cuts to local authority budgets have seen 26 per cent fewer people get help.” (p. 3)

The authors note that gross spending by local authorities on social care for older people has fallen by 9 per cent in real terms between 2009/10 and 2014/15. This is within the context of Central government funding to local government falling by 37 per cent in real terms between 2010/11 and 2015/16. The picture has not been even, with substantial variation across local authorities in terms of cuts/rises in spending. Various decisions, such as some transfer of NHS funding to social care, have helped to cushion the situation. However, the general picture has been one of cuts in statutory social care funding.

It is not surprising, then, that there has been a reduction of 26 per cent in the numbers of older people receiving local authority-funded social care, down from more than 1.1 million in 2009 to 853,615 in 2013/14. The steepest fall has been in the number receiving community support to help them stay independent and live at home.

Findings

Looking at the findings from the four case studies in how local authorities have managed the financial challenge, we see a bullet point list of actions mostly starting with ‘reductions in . . .’. A theme across all four sites was that there are no easy options for any further cuts. One authority reported that in order to meet this year’s savings target it is in danger of not meeting its statutory obligations to help people with eligible needs.

There are no easy options in how to deal with dwindling budgets at a time of increasing demand.

Amidst the cuts there were signs that local authorities were thinking differently. There were examples of maintaining or increasing spending on services aimed at reducing admissions to care homes. Authorities reported ‘new visions’ about the purpose of adult social care, that, for example, envisaged more prevention work, alliances with communities, working with local assets, and a greater purpose of promoting people’s independence rather than making them dependent on care. Yet this was all in that context of serious cuts to funding overall.

But, what happens to those who do not receive care? This is a difficult question to answer. In a search for an answer, the authors’ examine a range of existing data and previous reports. They found an estimate that one million people who have some level of difficulties with activities of daily living receive no formal or informal help with them. They found it difficult to say what happens to those who might have previously got care but now won’t.

The authors conclude:

“No one has a full picture of what has happened to older people who are no longer entitled to publicly funded care: the human and financial costs to them and those who care for them are mounting.” (p. 3)

Perhaps it doesn’t matter if the state shrinks and there is less state-funded social care for people. People may prove to be more resilient and other sectors of society may step up to help out. These are hopes that the authors did not feel too confident in:

“[the] vision of an enabled, independent older citizen, supported at home by family and community, turning to the state for care only in extremis, requires a vibrant voluntary and community sector, family members able and willing to play that role, and health and care services fully geared up to support people in their homes. We have not found evidence of these things being in place.” (p. 73)

As is often the case with these blogs there is much more in this report that there is space to cover here. There is a whole chapter, for example, on the implications of this situation on care providers. This includes a section on the challenges that these cuts bring to maintaining the quality of care. There is discussion about the role of self-funders, those people who pay for their own support, in sustaining the care provider sector. The impact on unpaid carers, i.e. family and friends who provide care for someone, is also discussed. The implications for the NHS of the pressures on adult social care are also discussed. None of these provide a much happier note to distract from the general picture discussed above. Amongst the positive notes are that the majority of those who do receive state-funded social care report are satisfied with it.

Conclusion

So, did you think about what you’d like to happen to you if you develop social care needs when you get older? How far does the situation found by Humphries et al. fit with your hopes? The authors comment that the public are not generally aware of the situation in social care and governments have never made clear policy intentions about who is to pay for it. This leaves many of the public at best in the dark, and at worst with unrealistic expectations about what will happen if they are older and need social care support.

As the authors comment throughout the report, we need a full and frank national discussion about social care. What dp we want from it, what are we prepared to pay for it, and how will we pay for it? Peter Beresford in his recent book All Our Welfare raises a similar point, the need to ask ourselves as a society, how are we going to look after each other? Do you think the current system provides the answer?

There needs to be a serious discussion of how we are going to look after each other in future.

Michael has worked at local, regional and national levels undertaking and managing research. His research interests include mental health, dementia, public involvement in research, and arts and care. He also has an interest in the interfaces between research, policy and practice and issues of implementation. Mike currently works as the Research Programme Manager for the NIHR School for Social Care Research an Senior Research Fellow at the PSSRU, LSE.